1-Stage delayed bulboprostatic anastomotic repair of posterior urethral rupture: 60 patients with 1-year followup

Purpose: The long-term results of delayed 1-stage bulboprostatic anastomotic urethroplasty for posterior urethral ruptures are evaluated. Materials and Methods: A total of 63, 1-stage delayed repairs of complete posterior urethral ruptures in 60 men with at least 1-year followup were reviewed. Two ruptures were due to gunshot wounds and 58 were secondary to a pelvic fracture. There were 58 repairs done by the perineal approach and 5 required an abdominal perineal approach. Results: Surgical complications included 2 (3%) rectal injuries, 3 (5%) repeat strictures that required reoperation and 20 (32%) repeat strictures that required dilation or visual internal urethrotomy. By 1 year after surgery all patients had a patent urethra and did not require further treatment. At 1 year 43 (72%) patients voided normally, 5 (8.3%) were areflexic and performed self-catheterization, 5 (8.3%) had urge incontinence and 5 (8.3%) had mild stress incontinence requiring no treatment. Moderate stress incontinence responded to imipramine in 1 case and collagen injection in 1. Of the patients who were potent preoperatively 31 (52%) remained potent postoperatively. Of the 29 (48%) patients who were impotent preoperatively and immediately postoperatively 9 regained potency at 1 year. However, at 1 year, the quality of erections of the 40 potent men was normal in only 22 (37%) and fair to poor in 18 (30%). Conclusions: The 1-stage delayed bulboprostatic anastomotic urethroplasty has a good longterm result with little morbidity for treatment of posterior urethral ruptures in men.